Vaccination In Transplant Recipients

Two issues limit the overall effectiveness of vaccination strategies in transplant recipients. First, transplant recipients may have declining antibody levels and diminished antibody responses to previous vaccine antigens once they become severely immunosuppressed (loss of previous immunity). Secondly, available evidence suggests that transplant recipients have diminished, although not absent, responsiveness to immunization (reduced vaccine efficacy). This is best demonstrated in kidney, liver and heart recipients after immunization with the pneumococcal vaccine.

Solid organ transplant recipients require periodic assessment of immunization status for vaccine-preventable illnesses, beginning during the pre-transplantation evaluation. Routine immunizations are administered or updated as long as possible before the transplant to allow for the development of immunity; these vaccinations include the hepatitis B series, hepatitis A, pneumococcal, yearly influenza, and tetanus-diphtheria. For VZV-seronegative transplant candidates, immunization with the varicella vaccine should be considered. In general, live attenuated virus vaccines are contraindicated in severely immunosuppressed hosts because of the potential for viral reactivation. Also, household contacts of transplant recipients should not undergo immunization with live viruses because of the potential for secondary infections.

Selected Readings

1. Chow JW, Yu VL. Legionella: a major opportunistic pathogen in transplant recipients. Sem Resp Infect 1998; 13:132-39.

2. Fishman JA, Rubin RH. Infection in organ-transplant recipients. New Eng J Med 1998; 338:1741-51.

3. Husain S, Wagener MM, Singh N. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis 2001; 7:375-381.

4. Ljungman P. p-Herpesvirus challenges in the transplant recipient. J Infect Dis 2002; 186(Suppl 1):S99-109.

5. Patel, R. Infections in recipients of kidney transplants. Infect Dis Clin N Am 2001; 15:901-952.

6. Patel R, Paya C. Infections in solid organ transplant recipients. Clin Microbiol Rev 1997; 10:86-124.

7. Patterson JE. Epidemiology of fungal infections in solid organ transplant recipients. Transpl Infect Dis 1999; 1:229-36.

8. Rubin R, Tolkoff-Rubin N. Antimicrobial strategies in the care of organ transplant recipients. Antimicrob Agents Chemother 1993; 37:619-24.

9. Sia IG, Patel R. New strategies for prevention and therapy of cytomegalovirus infections and disease in solid-organ transplant recipients. Clin Microbiol Rev 2000; 13:83-121.

10. Singh N. Antifungal prophylaxis for solid organ transplant recipients: seeking clarity amidst controversy. Clin Infect Dis 2000; 31:545-53.

11. Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis 1998; 27:1266-77.

12. Snydman DR. Infection in solid organ transplantation. Transplant Infect Dis 1999; 1:21-28.

13. Soave R. Prophylaxis strategies for solid-organ transplantation. Clin Infect Dis 2001; 33(Suppl 1):S26-31.

14. Villacian JS, Paya CV. Prevention of infections in solid organ transplant recipients. Transpl Infect Dis 1999; 1:50-64.

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